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CHAPTER 13 Vital Signs and Monitoring Devices Handout 13-1: Evaluating Content Mastery Student’s Name EVALUATION CHAPTER 13 QUIZ Write the letter of the best answer in the space provided. ______ 1. Which of the following is NOT a vital sign? A. Pulse C. Temperature B. Mental status D. Blood pressure ______ 2. You should obtain the first vital signs: A. during the scene size-up. B. during the focused history and physical exam. C. during the beginning of the initial assessment. D. immediately after determining responsiveness. ______ 3. The vital sign that is least useful in adults is: A. skin color. C. pupillary reaction. B. capillary refill. D. blood pressure. ______ 4. The patient that you would expect to have the slowest at-rest pulse rate is a(n): A. child. C. athlete. B. adult man. D. elderly woman. 1 ______ 5. An EMT should be most concerned with a pulse rate maintained above: A. 60 beats per minute. C. 100 beats per minute. B. 80 beats per minute. D. 120 beats per minute. ______ 6. In case of shock or later stages of blood loss, an EMT would expect the pulse to be: A. rapid, strong, and bounding. C. slow. B. rapid and thready. D. absent. ______ 7. The first pulse taken by an EMT on patients one year and older is the: A. carotid pulse. C. femoral pulse. B. radial pulse. D. pedis dorsalis pulse. ______ 8. If an EMT has trouble finding the radial pulse on a conscious patient, he should first: A. try the other side of the same wrist. B. press more gently. C. use the thumb to palpate the pulse. D. try the wrist on the other arm. ______ 9. A rapid pulse, or any pulse over 100 beats per minute, is called: A. tachycardia. C. diastolic. B. bradycardia. D. systolic. ______10. A person is considered febrile if he has a temperature greater than: A. 98.6°F. C. 101°F. B. 100°F. D. 99°F. ______11. In cases of children and infants, an EMT can expect to find the highest 2 normal respiration rates in a(n): A. adolescent. C. infant. B. preschooler. D. newborn. ______12. All of the following are signs of labored breathing EXCEPT: A. nasal flaring. C. grunting. B. retractions. D. palpitations. ______13. The respiratory sound that points toward medical problems such as asthma is: A. snoring. C. gurgling. B. wheezing. D. crowing. ______14. The respiratory sound that indicates a patient might need suctioning is: A. crowing. C. snoring. B. wheezing. D. gurgling. ______15. The skin color that indicates poor circulation is: A. pale. C. flushed. B. mottling. D. jaundiced. ______16. The skin color that indicates inadequate breathing or heart function is: A. pink. C. mottling. B. cyanotic. D. pale. ______17. For skin to be called “clammy,” it must be: A. moist and warm. C. damp. B. cool and dry. D. cool and moist. ______18. When checking pupils, an EMT should look for all of the following 3 EXCEPT: A. size. C. reactivity. B. equality. D. color. ______19. In cases of stroke or head injury, the pupils are likely to be: A. dilated. C. unequal. B. constricted. D. nonreactive. ______20. A normal systolic blood pressure for a 40-year-old female would be: A. 90. C. 130. B. 100. D. 140. ______21. When deflating the cuff of a sphygmomanometer, the “systolic” blood pressure is the: A. first sound. C. dullest sound. B. last sound. D. most muffled sound. ______22. A normal pulse oximeter reading is at least: A. 90 percent. C. 85 percent. B. 99 percent. D. 96 percent. ______23. For unstable patients, an EMT should take vital signs every: A. 20 minutes. C. 10 minutes. B. 15 minutes. D. 5 minutes. ______24. In distinguishing signs from symptoms, an example of a symptom would be: A. chest pain. C. retractions. B. slow pulse. D. cyanosis. 4 ______25. A normal blood glucose level is usually no more than: A. 60 mg/dL. C. 80 mg/dL. B. 200 mg/dL. D. 140 mg/dL. 5 HANDOUT 13-2: Reinforcing Content Mastery Student’s Name REINFORCEMENT IN THE FIELD Read the following real-life situation. Then answer the questions that follow. You’re looking out the window of the fire station watching the snow fall. The blare of the speaker breaks the peace: “Engine 54 respond to an elderly woman complaining of shortness of breath, 21 New York Avenue. Time out 0600.” “Just around the corner,” you say to your partner. As expected, you arrive on the scene in just a few minutes. You survey a quiet neighborhood, known for housing many retirees. Nothing in the immediate environment of the house indicates possible danger. The crew dons gloves as they walk up to the door. After you knock on the door, a woman’s voice invites you to enter. Upon entering, you find an elderly woman sitting upright on an overstuffed chair in the living room. She is awake and responsive to your questions. Her chief complaint is that she “can’t breathe.” Your general impression is that she is in some degree of breathing distress. The woman has an open airway, but her breathing is labored and noisy. One crew member starts to administer high-concentration oxygen by nonrebreather mask. While oxygen is administered, you continue with patient assessment. The woman’s pulse is rapid, faster than 100 beats per minute. You advise the lieutenant that the patient is “high priority.” She, in turn, advises the incoming ambulance of the patient’s condition and priority. The ambulance reports that weather conditions will delay their arrival by several minutes. One crew member proceeds to obtain vital signs as you begin the patient interview. You ask the patient to describe her symptoms. You ask, “Have you had any coughing or bloody sputum?” She responds to your questions with choppy answers, a sign of difficulty breathing. You ask if 6 the patient has any allergies. You also find out if she is taking any medications. Finally, you inquire whether she has had similar episodes like this one. The crew member taking the vital signs interrupts briefly to relate his findings. He reports that the patient’s heart rate is 110 beats per minute, strong and slightly irregular. He also indicates a blood pressure of 160/110, a temperature of 98.8° F, and a respiratory rate of 28, with labored breathing. He also reports a blood glucose monitor reading of 140 mg/dL. The woman offers, “Had a nagging cough for several days. Last night I had so much trouble breathing that I got up to sit in the easy chair. I’ve been sleeping on and off all night.” She denies any allergies, but did suffer a heart attack several years ago and a subsequent “heart failure.” She is on digoxin, Lasix, and potassium supplements. You ask the patient when she last had anything to eat or drink. Her answer completes your history. As you write down the information, the ambulance pulls up. 1. What are the patient’s baseline vital signs? 2. How long should the crew member spend in taking the patient’s pulse? Why? 3. Which parts of the passage describe the patient’s symptoms? 4. What priority would you assign this patient? 5. What vital sign(s) are the most important in determining her priority status? 6. What vital sign(s) are the least important in determining her status? 7 HANDOUT 13-3: Reinforcing Content Mastery Student’s Name CHAPTER 13 REVIEW Write the word or words that best complete each sentence in the space provided. 1. The most important part of the patient assessment is the ____________________________ ____________________________. 2. The outward signs of what is going on inside a patient’s body are the ____________________________ ____________________________. 3. The first set of vital signs an EMT obtains is called ____________________________ vital signs. 4. The rhythmic beats felt as the heart pumps blood through the arteries is called the ____________________________. 5. A rapid pulse, usually over 100 beats per minute, is known as ____________________________. 6. A slow pulse, usually below 60 beats per minute, is known as ____________________________. 7. Pressing too hard on the ____________________________ artery can result in a slowing of the heart. 8. If the pulse rate, rhythm, or character is not normal, an EMT should continue taking the count for ____________________________ seconds. 9. For determination of vital signs, an EMT is concerned with two respiratory factors: ____________________________ and ____________________________. 10. An EMT should be concerned with an adult patient with a respiratory rate above ____________________________ breaths per minute or below 8 ____________________________ breaths per minute. 11. Snoring, wheezing, gurgling, and crowing are examples of ____________________________ breathing. 12. ____________________________ sounds usually mean that an EMT needs to suction the patient’s airway. 13. A good place for an EMT to assess a patient’s skin temperature is a patient’s ____________________________. 14. The best places for an EMT to assess the skin color of a dark-skinned patient are the inner eyelids, lips, and ____________________________ ____________________________. 15. “Goose pimples” or “goose bumps” are associated with exposure to ____________________________, ____________________________, or ____________________________. 16. In cases of stroke, a patient’s pupils will probably be ____________________________. 17. The proper term for a blood pressure cuff is ____________________________. 18. The force of blood against the walls of the blood vessels is known as ____________________________ ____________________________. 19. The center of the bladder of the blood pressure cuff should be over the ____________________________ artery. 20. Taking blood pressure by use of the fingertips is known as ____________________________. 21. A(n) ____________________________ is objective—something an EMT sees, hears, feels, and smells when examining a patient. 22. A(n) ____________________________ is subjective—an indication an EMT cannot ob- 9 serve but that the patient feels and describes. 23. A person with a pulse oximetry level less than ___________________________ is considered to be in _______________ hypoxia. 24. A blood glucose level less than ____________________________ is considered to be low. 25. In introducing themselves to patients, EMTs should try to position themselves at ____________________________ ____________________________ with the patients. 10 HANDOUT 13-4: Reinforcing Content Mastery Student’s Name VITAL SIGNS AND MONITORING DEVICES MATCHING Write the letter of the term in the space provided next to the appropriate description. A. Brachial B. Blood pressure C. Auscultation D. Bradycardia E. Carotid F. Constrict G. Dilate H. Respiration I. Pupil J. Sign K. Symptom L. Radial M. Systolic N. Tachycardia O. Vital signs ______ 1. Pressure created when the heart contracts ______ 2. Pulse felt in the major artery in the neck ______ 3. Rapid pulse, usually above 100 beats per minute ______ 4. Force of blood against the walls of blood vessels ______ 5. Objective indication of a patient’s condition 11 ______ 6. Pulse felt in the major artery of the upper arm ______ 7. To get smaller, as in the pupils of the eyes ______ 8. Slow pulse rate, usually below 60 beats per minute ______ 9. Act of breathing in and out ______10. Subjective indication of a patient’s condition ______11. Outward signs of what is going on inside the body ______12. Black center of the eye ______13. Listening, as in use of a stethoscope for characteristic sounds ______14. To get larger, as in the pupils of the eyes ______15. Pulse felt at the wrist 12 HANDOUT 13-5: Reinforcing Content Mastery Student’s Name REASONED JUDGMENTS ABOUT VITAL SIGNS Evaluate your ability to make a reasoned judgment about vital signs and the monitoring devices by writing the letter of the probable cause next to the correct sign. (Each answer can be used only once.) I. Respiratory System Sign __________ Probable Cause 1. Snoring Medical problem that cannot be treated on the A. scene __________ 2. Wheezing B. Fluids in the airway __________ 3. Gurgling C. Asthma __________ 4. Crowing D. Blocked airway II. Skin Temperature Sign Probable Cause __________ 5. Cool, clammy E. Fear __________ 6. Hot, dry F. High fever __________ 7. Cold, dry G. Shock __________ 8. “Goose pim- H. Exposure to cold ples” III. Skin Color Sign __________ Probable Cause 9. Cyanotic I. Shock 13 __________ 10. Pale J. Hypoxia __________ 11. Flushed K. Liver problems __________ 12. Jaundiced L. High blood pressure IV. Pupils Sign Probable Cause __________ 13. Dilated M. Stroke __________ 14. Constricted N. Blood loss __________ 15. Unequal O. Drugs V. Temperature Sign Probable Cause __________ 16. 101°F P. Heat stroke __________ 17. 93°F Q. Hypothermia __________ 18. 105° R. Infection 14 Chapter 13 Answer Key HANDOUT 13-1: Chapter 13 Quiz 1. B 2. B 3. B 4. C 5. D 6. B 7. B 8. D 9. A 10. B 11. D 12. D 13. B 14. D 15. A 16. B 17. D 18. D 19. C 20. C 21. A 15 22. D 23. D 24. A 25. D HANDOUT 13-2: In the Field 1. First complete set of vital signs: heart rate 110 beats per minute, blood pressure 160/110, respiration rate of 28 and labored. 2. Because the pulse is irregular, the crew member should take it for 60 seconds. 3. Symptoms include conditions described by the patient, such as her nagging cough for several days, the lack of sleep the prior night, the fact that she needs to sit upright, the denial of allergies, and background on cardiac problems and related medications. 4. The patient is high priority because she is breathing rapidly. She also has a sustained rapid pulse. Remind students that the decision for high-priority transport is made early by EMTs, especially in the absence of advanced life support. 5. The rapid breathing and sustained rapid pulse are the most important. 6. The blood glucose level and temperature are the lowest because they are normal. HANDOUT 13-3: Chapter 13 Review 1. chief complaint 2. vital signs 3. baseline 4. pulse 16 5. tachycardia 6. bradycardia 7. carotid 8. 60 9. rate; quality 10. 24; 8 11. noisy 12. Gurgling 13. forehead 14. nail beds 15. cold, pain, fear 16. unequal 17. sphygmomanometer 18. blood pressure 19. brachial 20. palpation 21. sign 22. symptom 23. 85; severe 24. 60 mg/dL 25. eye level HANDOUT 13-4: Vital Signs and Monitoring Devices Matching 17 1. M 2. E 3. N 4. B 5. J 6. A 7. F 8. D 9. H 10. K 11. O 12. I 13. C 14. G 15. L HANDOUT 13-5: Reasoned Judgments About Vital Signs 1. D 2. C 3. B 4. A 5. G 6. F 18 7. H 8. E 9. J 10. I 11. L 12. K 13. N 14. O 15. M 16. R 17. O 18. P 19